HomeMy WebLinkAbout11-10-10J
15056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 21 10
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
File Number
0693
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
204-30-8136 06/29/2010 ' 11/26/1924
................................ .
Decedent's Last Name Suffix Decedent's First Name MI
Shughart Paul H
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name _ MI
__
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE:
REGISTER OF WILLS
FILL tN APPROPRIATE OVALS BELOW
:~i 1. Original Return 2. Supplemental Return 3. Remainder Returns (date of death
prior to 12-13-82)
4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate 7. Decedent Maintained a Living Trust ~___ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name
__ Daytime Telephone Number
Esq.
Michael Scherer (717) 249-6873
, ~
~~;,
Firm Name (If Applicable) _ """'
REGISTER~F j~1~.LS USE (#~tt.Y -., ,
Baric Scherer , ;-, ~ m~
First line of address
_ ', .;,. ~--,-~ --- i ,._ _,_,.
.
__ - ; .
C~ .
19 West South Street
~~
-' %°~
.,
Second line of address ~-->> _.T. ~ =~'= -
.__ - -.j
_..
..1 U.) --
__, . .
'
_
City or Post Office State ZIP Code _ DATA F!ILEO G:~ : .. ;;
__ _ ~.
Carlisle PA 17013
Correspondent's a-mail address: mscherer@baricscherer.com
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT RE OF PERSO RESPONSIBLE FOR FILING RETURN DATE
~ - /~.. ~„ Zo/a
ADDRESS
584 treason Road, Carlisle, Pennsylvania 17015 __
SIGNI~U~ ~ Pf2EP/~RER OTHER THAN REPRESENTATIVE DATE
ADDICL~~ - - - v
19 West South Street, Carlisle, Pennsylvania 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
J
15056052059
REV-1500 EX
Decedent's Social Security Number
Paul H Shughart
' .204-30-8136
s Name:
Decedent
RECAPITULATION
1. Real estate (Schedule A) . ........................................
1
... .
74,405.65
2. Stocks and Bonds (Schedule B) ................................... .... 2.' 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 0.00
4.
9 9 ( ) .........................
Mort a es & Notes Receivable Schedule D 4.
.... 0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... .... 5. 37,022.19
6. Jointly Owned Property (Schedule F) Separate Billing Requested ... .... 6. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
0
00
(Schedule G) °; 'Separate Billing Requested.... .... 7. .
8. Total Gross Assets (total Lines 1-7) ................................ .... 8. 111,427.84
9. Funeral Expenses & Administrative Costs (Schedule H) ................. .... 9. 14,695.52
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ .... 10. 0.00
11. Total Deductions (total Lines 9 & 10) ............................... .... 11. 14,695.52
12. Net Value of Estate (Line 8 minus Line 11) .......................... .... 12. 96,732.32
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................... .... 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 14. 96,732.32
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 96,732.32
16,
4,352.95
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE .........................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
15056052'.059
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 10 0693
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
Paul H Shughart 204-30-8136
STREET ADDRESS
357 McAllister Church Road
CITY
Carlisle STATE
PA ZIP
17015
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 4 352.95
2. Credits/Payments
A. Spousal Poverty Credit _
B. Prior Payments 4,900.00
C. Discount 217.65
Total Credits (A + B + C) (2) 5,117.65
3. Interest/Penalty if applicable
D. Interest _
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) 764.30
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :.......................................................................................... ^
b. retain the right to designate who shall use the property transferred or its income : ............................................ ^
c. retain a reversionary interest; or .......................................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. ^
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ^x ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX+ (5-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Paul H. Shughart 21-10-0693
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of thE~ relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
tiT more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98) ~
r~ SCHEDULE E
~. . .
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Paul H. Shughart 21-10-0693
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Rent rebate
500.00
2. Nationwide claim check- storm damage to real estate owned by decedent 5,822.66
3. The Sentinel refund 27.46
4. Century Link refund 5.15
5, Sale of car to third party in arm's length transaction: 1992 Mercury Marquis 1,200.00
6. Constitution Life refund 10.62
7. Nationwide Insurance: refund of automobile insurance 47.80
8. Comcast refund
27.10
9. Proceeds from auction of personalty 7,176.02
10. Orrstown Bank checking account # 106002046 7 879 69
11. Orrstown Bank savings account # 706001284 14,325.69
TOTAL (Also enter on line 5, Recapitulation) $ I 37,022.19
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHED~lLE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Paul H. Shughart 21-10-0693
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~ ~ Ewing Brothers Funeral Home 5,318.89
2~ Country Butcher 200.00
s. Kathryn Huntzinger: miscellaneous funeral expense 265.00
4. Arlene Jennings; flowers 203.96
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)IEIN Number of Personal Representative(s)
Street Address
City .State Zip
Year(s) Commission Paid: 2010
2. Attorney Fees 7, 500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State .,Zip
Relationship of Claimant to Decedent
4. Probate Fees 311.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
~. The Sentinel (legal advertising) 166.30
s.. Cumberland Law Journal 75.00
9. Cole Wark: lawn mowing 60.00
~o. PP&L 124.98
~ ~ ~ Orrstown Bank: checks 21.75
~ 2~ George Young: battery for tractor 53.00
TOTAL (Also enter on line 9, Recapitulation) $ 1.4 , 6 9 5 0 5 2
(If more space is needed, insert additional sheets of the same size)
Estate of Paul H. Shughart
Estate No. 21-10-0693
Schedule H Continued:
13. West Pennsboro Fire Company $ 50.00
14. Wayne Myers: plumbing services $ 55.80
15. Cole Wark: lawn mowing $ 65.00
16. PP&L $ 71.01
17. PP&L $ 40.58
18. Philip Huntizinger miscellaneous expenses $ 82.75
19. Cole Wark: lawn mowing $ 30.00
REV-1513 EX+ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Paul H. Shughart 21-10-0693
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 • Kathryn M. Huntzinger, 584 treason Road, Carlisle, PA 17015 daughter 1 / 4
2 • Shirley D. Young, 2381 Enola Road, Carlisle, PA 17013 daughter 1 / 4
3• Arlene R. Jennings, 91 McAllister Church Road, Carlisle, PA 17015 daughter 1 / 4
4. Paula Grumbling, 2239 Santa Anita Road, Norco, CA 92860 daughter 1 / 4
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON RE V-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ 0.00
(If more space is needed, insert additional sheets of the same size)
~Qat~~ond ~t~nt
I~
PAUL H. SHUGHART
I, PAUL H. SHUGHART, of Carlisle, Cumberland County, Pennsylvania, being of sound
mind, memory and understanding, do hereby make, publish and declare this as and for my
Last 1.nlil! and Testamen±, hereby revoking all other `,rills and codicils heretofore made by n ~,e.
ITEM ONE: I direct the payment of my debts and the expenses of my last illness and
funeral from my estate as soon after my death as conveniently may be done.
own a cemetery lot at .Cumberland Memorial Gardens in Carlisle, Pennsylvania and I
desire to be interred in that lot with my wife, EVELYN W. SHUGHART.
I authorize my personal representative to expend funds from my estate, in such amount
as my personal representative shall consider necessary and desirable for the cost of my
interment.
ITEM TWO: I give, devise and bequeath such of my personal property as may be
listed on a signed and dated memorandum kept with my Will to the persons named thereon,
provided they survive my death. Should such a memorandum not be found with my Will, it
shall be conclusively presumed that none was prepared, and all of my personal property shall
pass according to the remaining provisions of this Will.
ITEM THREE: I give, devise and bequeath the rest, residue and remainder of my
estate of whatever nature and wherever situate to my daughters, KATHRYN M.
HUNTZINGER, SHIRLEY D. YOUNG, ARLENE R. JENNINGS and PAULA J. GRUMBLING,
in equal shares, per stirpes.
Page 1 of 4
ITEM FOUR: I direct that no executrix, or other fiduciary named, nominated, or
L
..,
tom,
~5
p,~
`~~
appointed by this my Last Will and Testament shall be required to post any bond or give any
security of any type for any purpose whatsoever, any law or rule of the Court of the
Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. I
direct that the law of the Commonwealth of Pennsylvania shall apply to any interpretation or
application of the validity of this instrument.
ITEM FIVE: Any and all payment or payments of any sum or sums, whether in cash or
in kind and whether for principal or income, payable to an heir, or any of them, shall be made
upon the sole receipt of the respective individual to whom the payment is made, and free from
anticipation, alienation, assignment, attachment, and pledge, and free from control by the
creditors of any such beneficiary.
ITEM SIX: I confer upon my executrix the right to sell or otherwise convert any real
or personal property at public or private sale, at such time or time, in such manner, and for
such price or prices, and on such terms and conditions as my executrix shall determine, and to
execute and deliver good and sufficient conveyances, assignments and transfers of the
property, without liability of any purchaser for the application of any consideration; to borrow
money and to secure its payment by mortgage of real or personal property, pledge of
investments, or otherwise, without liability on the part of the lenders to see to the application
thereof; to retain any investments at discretion; to invest and reinvest at discretion, without
restriction to so-called "legal investments;" to make distribution in cash or in kind; to allocate
and distribute different kinds or disproportionate shares of property or undivided interests in
property among beneficiaries, in case or in kind, or partly in each; and to do all other acts and
things necessary or appropriate in the management, administration and distribution of my
estate.
Page 2 of 4
ITEM SEVEN: I appoint my daughter, KATHRYN M. HUNTZINGER, executrix of this
my Last Will and Testament. Should my said Executor fail to survive me or for any reason fail
to qualify as executrix, I then appoint my daughter, SHIRLEY D. YOUNG, alternate executrix
of this my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, consisting of four (4) typewritten pages, the first two (2) of which bear my
signature in the margin for the purpose of identification, this 20t" day of July, 2007.
~~7~, ~ ~ ~ - -(SEAL)
Paul H. S~hughart
Signed, sealed, published and declared by the above named testator, Paul H.
Shughart, as and for his Last Will and Testament, in the presence of us, who, at his request, in
his sight and presence, and in the sight and presence of each other, have hereunto
subscribed our names as witnesses.
WITNESS:
e_
Michael .Scher r
563 Mountain Road
Boiling Springs, Pennsylvania 17007-9520
Andr a M. Barrick
236 North Baltimore Avenue, Apt. 4
Mt. Holly Springs, Pennsylvania 17065
Page 3 of 4
Ilr
r'~ I ~ ~ ,
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, Paul H. Shughart, Michael A. Scherer and Andrea M. Barrick, the testator and the
witnesses, respectively, whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the testator signed
and executed the instrument of his Last Will and Testament, and that he signed willingly and
that he executed as his free and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the testator, signed the Will as
witnesses, and that to the best of their knowledge, the testator was at the time eighteen (18)
years of age or older, of sound mind and under no constraint or undue influence..
Sworn to and subscribed before me this 20th day of July, 2007.
.~a-;
,~ ~ ~.
COMMONWEALTH OF FENNg~ Y~NIA
Natariat Seal
Amanda L. Fisher, Notary public
Carlisle Bora, Curnticrl~nd County
My Commission >vxpires Apr.1 ~, 2010
Member, ~ar-ri~ylv~ni~ ~~~eoi~tlan o} N®tares
Page 4 of 4
. ~~ A, Settlement Statement (HUD-1)
OMB Approval No. 2502-0265
~'
R Tvnw of I .nan - __
1. [~ FHA 2. ~ RHS 3. []Conv. Unins.
4. ^ VA 5. ^Conv. Ins. 6. File Number:
RE10-155 7. Loan Number: 8. Mortgage Insurance Case Number:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shc-wn. Items
marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name & Address of Borrower(s):
William Brownewell
762 Grahams Woods Road, Newville, PA 17241 E. Name & Address of Seller(s):
Estate of Paul H. Shughart
357 McAllister Church Road, Carlisle, PA 17015
F. Narne & Address of Lender:
Orrstown Bank
2695 Philadelphia Avenue, Chambersburg, PA 17201 G. Property Location:
357 McAllister Church Road, Carlisle, PA 17015
762 Grahams Woods Road, Newville, PA 17241
Place of Settlement:
1 Irvine Row, Carlisle, Pennsylvania 17013 H. Name of Settlement Agent:
Duncan & Hartman, P.C. (717) 249-7780
I. Closing Date:
10-18-2010 Disbursf;ment Date:
14-22-2010
J. Summer of Borrower's Transaction K. Summer of Seller's Transaction
101
Contract sales rice 75 000.00 401. Contract sales rice 75 000.00
.
102. Personal ro ert 402. Personal ro ert
104. 404.
105. 405.
Ad'ustments for items aid b seller in advance Ad'ustments for items aid b seller in advance
107. Count taxes 10-18-2010 to 12-31-2010 46.89 407. Coun taxes 10-18-2010 to 12-31-2010 46.89
108. Assessments 10-IS-2010 to 6-30-2011 113.76 408. Assessments 10-18-2010 to 6-30-2011 113.76
c
1 -0. 410.
III. 411.
1 12. 412.
200. Amounts Paid b or in Behalf of Borrower 500. Reductions in Amount Due to Seller
201. De osit or earnest move 7 500.00 501. Excess d osit see instructions
203. Existin loans taken sub'ect to 503. Existin loans taken sub'ect to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
c
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller
210. Cit /town taxes to 510. Cit /town taxes to
211. Count taxes to 511. Coun taxes to
213. School taxes 513. School taxes
214. 514.
21 b. 516.
217. 517.
2 l 8. 518.
220. Total Paid b /for Borrower 82 500.00 520. Total Reduction Amount Due Seller 755.00
300. Cash at Settlement fromlto Borrower 600. Cash at Settlement to/from Seller
302. Less amounts aid b /f'or Borrower line 220 82 500.00 602. Less reductions in amount due seller line 520 755.00
303. Cash From 3'o Borrower 2 433.94 603. Cash To From Seller _„ 74 405.65
Settlement ('har ec
L
~
„
` 7 .Tot I Real Estate Broker Eees Paid From Paid From
o = Borrowers Seller's
,?ivision of commission line 700 as follows: Funds at Funds at
701. S to Settlement Settlement
~;
703. Commission aid at Settlement
704.
SOU. lterns Pa able in Connection with Loan
801. Our on ination char e $ 1 350.00 (from GFE #1)
from GFE #2
803. Your ad~usted on ination char es (from GFE A) 1 350.00
804. A sisal tee to (from GFE #3) 875.00
805. Credit re ort to (from GFE #3) 28.66
from GFE #3
807. Flood certification (from GFE #3) 10.00
808.
810.
811.
812.
814.
900. Items Re uired b Lender to be Paid in Advance _
90 (. Dail interest char es from (from GFE #lo)
from GFE #3
903. Homeowner's insurance 1 ears to Erie Ins. POC $100 (from GFE #11) 494.00
904.
905. ~.
000. Reserves De osited With Lender
from GFE #9
1002. Homeowner's insurance months $ er month $
1003. Mort a e insurance months $ er month $
1004. Pro ert taxes months $ er month $
1006. School taxes months $ er month $
i 007. A re ate Ad ~ ustment - $
3100. Title Char es
from GFE #4
1 102. Settlement or closin tee $ 175.00
1 103. Owner's title insurance (from GFE #5)
1 104. Lender's title insurance $ 708.75
i 106. Owner's title olic limit $ 75 000.00
1 107. A ent's ortion of the total title insurance remium $ 772.44
1108. Underwriter's ortion of the total title insurance remium $ 136.31
l i 10. Closin Protection Letter $75.00
t i 1 1. Notar $20.00
1200. Government Recordin and Transfer Char es
from GFE #7
1202. Deed $62.00 Mort a e $82.00 Release $
1203. Transter taxes (from GFE #8) 750.00 750.00
1204. Cit /Count tax/stam s Deed $750.00 Mort a e $
1206.
1300. Additional Settlement Char es
1301. Re uired services that ou can sho for (from GFE #6)
1302. $
1304. Tax Certification to Deborah Pi er .Tax Collector 5.00
l 305.
1400. Total Settlement Char es enter on lines 103 Section J and 502 Section K 4 90,5.41 755.00
CERTIFICATION : t have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true
and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that
1 received a copy of the HUD-1 Settlement Statement.
Signature of Borrower Signature of Borrower
-1fi
Signature of Seller
Signature of Seller
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds disbursed or to be disbursed by the
nsaction.
/,~,- /~" s~ /Ca
Date
r
. ~
• r
Y
Char es That in Total Cannot Increase Mare Than 10%
Government recordin char es #1201
Credit Re ort # 805
Tax Service Fee # 806
Title services and lender's title insurance #1101
Owner's title insurance #1103
Total
Increase between GFE and HUD-1 Char es
Char es That Can Chan e
Initial d osit for our escrow account #1001
Homeowner's insurance # 903
Title services and lender's title insurance #1101
Owner's title insurance #1103
i .na n TPrmC
Good Faith HUD-1
1 350.00 1 350.00
Good Faith HUD-t
185.00 144.00
28.66 28.66
75.00 75.00
1 173.66 1 132.66
$ -41.00 or -3.49
HUD-1
494.00
1.178.75
Your initial loan amount is $ 75,000.00
Your loan term is 2 years
Your initial interest rate is 6.25
Your initial monthly amount owed for principal, $ 398.12 includes
interest, and any mortgage insurance is ^ Principal
® Interest
^ Mort a e Insurance
Can your interest rate rise? ® No^ Yes, it can rise to a maximum of %. The first change will be
on and can change again every after
. Every change date, your interest rate can increase or decrease
by %. Over the life of the loan, your interest rate is guaranteed to never be
lower than % or higher than %.
Even if~you make payments on time, can your loan ® No^ Yes, in can rise to a maximum of $
balance rise?
Even if you make payments on time, can your ® No^ Yes, the first increase can be on and the monthly amount
monthly amount owed for principal, interest, and owed can rise to $
mort a e insurance rise? The maximum it can ever rise to is $
Does your loan have a prepayment penalty? ® No^ Yes, your maximum prepayment penalty is $
Does your loan have a balloon payment? ^ No® Yes, you have a balloon payment of $ 75384.22 due in
2 ears on
Total monthly amount owed including escrow account ® You do not have a monthly escrow payment for items, such as praperty
payments taxes and homeowner's insurance. You must pay these items directly yourself.
^ You have an additional monthly escrow payment of $
that results in a total initial monthly amount owed of $ .This includes
principal, interest, any mortgage insurance and any items checked below:
^ Property taxes ^ Homeowner's insurance
^ Flood insurance ^
^ ^
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender.
Previous editions are obsolete Page 3 of 3 HUD-1
r
j
V
Parcel No: 46-18-1390-005
EXECUTRIX'S DEED
MADE THE ~ ~ day of ~G ~~C,e~ in the year of our Lord Two Thousand Ten
(2010).
BETWEEN KATHRYN M. HUNTZINGER, EXECUTRIX OF THE ESTATE OF PAUL H.
SHUGHART, late of Cumberland County, Pennsylvania, hereinafter referred to as:
Grantor,
and WILLIAM BROWNEWELL, a married man, of Cumberland County, Pennsylvania,
hereinafter referred to as:
Grantee,
WITNESSETH, the said Paul H. Shughart, in his lifetime and at the time oaf his death on
June 29, 2010, was seized in fee of and in certain real estate known as 357 McAllister
Church Road, Carlisle, Cumberland County, Pennsylvania, being parcel number 46-18-
1390-005; and
WHEREAS, an estate was opened with in the Office of Register of Wills, i.n and for
Cumberland County, Pennsylvania under Estate No. 21-10-0693, provided inter alia, as
follows:
ITEM SIX: I confer upon my executrix the right to sell or otherwise convert any
real or personal property at public or private sale...
ITEM SEVEN: I appoint my daughter, KATHRYN M. HUNTZINGER, executrix
of this my Last Will and Testament.. .
NOW THIS INDENTURE WITNESSETH, that the said Grantor, by virtue of the
power and authority aforesaid, in said Will contained, and in consideration of the sum
of Seventy Five Thousand and 00/ 100 Dollar ($75,000.00) to it paid by the said Grantee,
at and before the unsealing and delivery of these presents, the receipt whereof is hereby
acknowledged, has granted, bargained, sold and conveyed and does hereby grant,
bargain, sell and convey to the said Grantee, his heirs and assigns:
~.
ALL that certain tract of land situate in West Pennsboro Township, Cumberland
County, Pennsylvania, more fully bounded and described as follows:
BEGINNING at a point in the center of the public road leading from the state road to
Bergner's Mill, at corner of other land now or formerly of Lester L. Warner and wife;
thence by the same, South Eighty-nine (89) degrees East, through an iron pin in the
fence line, a distance of Two Hundred Sixty-three and Forty-seven hundredths (263.47)
feet to an iron pin in line of land now or formerly of Jacob Baer; thence by the same,
South Nine (9) degrees Fifteen minutes West, a distance of One Hundred Nine anal
Ninety-three hundredths {109.93) feet to a fence corner in line of land now or formerly
of Robert Hair; thence by Line of Iand of said Robert Hair, along a fence, North Eighty-
nine (89) degrees West, through an iron pin in the fence line along said public road, a
distance of Two Hundred Sixty-four and 0 tenths (264.00) feet to a point in the center of
said public road, thence by the center line of said public road, South (erroneously
referred to as North in prior Deed} Nine (9) degrees Thirty (30) minutes East, a distance
of One Hundred Ten {110) feet to a point, the place of BEGINNING.
BEING the same premises which Lauran O. Charles and Melva M. Charles, his wife, by
Deed dated April 1,1970 and recorded April 1,1970 in the Office of the Recorder of
Deeds in and for Cumberland County, Pennsylvania, in Deed Book O 23, Page 860,
granted and conveyed unto Paul H. Shughart and Evelyn W. Shughart, his wife. The
said Evelyn W. Shughart died May 30, 2007 whereby title became vested in her
surviving spouse Paul H. Shughart. The said Paul H. Shughart died June 29, 2010,
whereby title became vested by law in his estate.
AND the said Grantor hereby covenants and agrees that she will warrant specially the
property hereby conveyed.
V WITNESS WHEREOF, said Executrix of the Estate of Paul H. Shughart, as Grantor
s hereunto set her hand and seal the day and year first above written.
'TED, SEALED AND DELIVERED
~-IE SENCE OF
~-- ~ ~ (SEAL}
state of P ul H. Shughart
By: Kathryn M. Huntzinger, Executrix
r
a
COMMONWEALTH OF PENNSYLVANIA }
): SS.
COUNTY OF CUMBERLAND )
On this, the day of , 2010, before me, the
undersigned officer, personally appeared Kathryn M. Huntzinger, Executrix of the
Estate of Paul H. Shughart, known to me (or satisfactorily proven} to be the person
whose name is subscribed to the within instrument, and acknowledged that she
executed the same in the capacity therein stated and for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
CERTIFICATE OF RESIDENCE
(seal)
I hereby certify that the precise residence and complete post office address of the
within Grantee is: _~~~ ~tc~~tc.~.o I,~aG;~' , r~ c~ czc..C' ~ Ylu._~„~,.-~.~..u~ ~ '~/~- ~~ ~ ~/
~~~{. ,~,~, 2010.
Attorn f Grantee
BARK SCHERER
19 WEST SOUTH STREET
CARLISLE, PENNSYLVANIA 17013
IIIL-1~-2010~`~1Ck{i ~~:~ 52
~~~~~ ~
ORRSTO~NN
__
~YNANCIA.L SERVICES, INC.
~ 7'rudit+~~t of F,a;cell~7tc~
Michael A. Scherer, Esq.
Bark & Scherer
I ~ 'W'est South Street
Carlisle, 1'A 17013
~`ax 24~-5755
.July 19, 2Q ~. Q
Re: Estate of haul H. Shughart
Social Security Number 2U4-3tJ-8136
Date ref Death .June 29, 2010
~'T IS I-IERERBY CERT.T.~'~.D THAT THE ABOVE NA1VfED DECEDENT, ON THL~'
AEt~VE DATE, FAD T,~,~E FO.~~OT~fTING ACCOZ.INTS MTH ORRSTOWIV' .~3AN'~-
C~IFCKI,NO ACCOZ.INT
Account No. ~-
Account G -
]aate Opened -
Joint Account (name/date) -
Balance -
Accrued Interest -~
zo~oa2o4~
S0+ Interest Check
~/~S/oz
Evelyn W. Shughart 4 f I $ f 01
$7,879.9
x.03
S'~1V7NG~ ACCOUNT
Account No. --
Account Type --
Da.te Opened --
Jc~int Account (Warne/date) -
13alance -~
Accrued. Interest -
7o6a01.284
Statement Savings
$/2/t~~.
Evelyn W. Shughaxt 8 / 8 / o l
~ 14,325.69
$.$3
Best Regards,
Vicki L. Oullixon
Cusiaxner Service Specialist
P 001/001
77 East Icing Street, Shippensburg, Iaeiinsylvania I72S7
1~ l ~2/2?:_? ~-. ~. r 71 '?585151
'0464
PAUL H
E E V E EYIV W SHUGHART
584 GREASan~ RCtAD
D
GARLl5LE
PA 17015
~-
0
0
Cheek Number: 58388845
Check Issued: 1 ~-~e-zo ~ o
PAGE Q2
W
o~
,n
0
PaliCy Number; 5837H0934326
Refund Amount; $ ~'ti221 • q0
Thls refund wes issued for the 1~oitowing reason(s):
s~
~_
_~
~~ ~' ~ W
I
if you have Arty ctuestl4ns, please contact yc-ur Nationwide representative.
AR ~RC1VE
717-243-7323
1425943
Qetach Stub Before Cashing And Keep For Your Record
-r;~;~~.. °'~~!'~'~'','~~"!~"I.hl~~ ~~'~~~p~`~ai~~tw~.~,~,1~~:~t~1'~~'-:~~;g.'~' ~:~~~`"~z?~t~"`~?~T_J:~~~~~Mr':~P~'~~:~'1'~','~T: .., _ ,,:.._, <, _ ~ ~C~~~S~(~
..,.. ._.... ~' ~ T'~ JV ~.ri l- ~~WlY1P ~~ ~,. .. ~i• `~~'., ,:~1~.~t,W car ~~~~; `" ~. ii ~!~~e ~~~~1,. 11P1~(. ,..
~~ I~ ~~~ Z +~~. ~ ~~,~ ~~, '~ tVdt~Ot'1W~de s: . ,~~~ ~ i ~ ~, rig;
pp ~;~, n ``,J j,,
. ~ 1, a ~~~1i1~ ,~ ,. , ~, ^~ Wit P ~YW t ~ • V ~ ,~ t't' 0; "~ .3 ~ ~ K ^ ~' , y ~.~ ~ ~,.
~~:~~` ,YI~~ a 4 " ,~ "y' n,~ '•+~'; ~ ~ ,i ~;~YI~~Jrc~r1CE:~: •.^ '",, ~,~y„ ~ ~ l 4~.~y~ ~i~~n~ t,, ~t'i;,W
~~ ~ ~~~ ~' ~~ tide ~Wi ~' ~~'~ ~~Q~~~~~ ~ _ ~~~~~ ~ ~~M~~ a ~ ~ r, ,,- „~, ,i
°~t~7i1=1~~ ~,~, ,.~,~,i ~ ~ i~ ~,.
'~ :~~. r. ~/ r~~'.. ~;'i ~1g~(:Y,ri. ~,~ A.~,,..1 \~.~ ... ... r ~: "-.. •.,.. (a ii~f ~lVt~~l ~~µ~io 'I~i, ..,,fill`s .,, , I,rr,t.~~i n'r .(i'. t i~1i ~~t iy, ~ , ~~ ~ i.
' ,yt,. ,.:~qt~}1..,.; -„ t~ ~~ ?'.i:„;~ . .; .; ,,, ,..::..:,. ,.. ~...,.~,: ~., ., ,'i ! .'~~i.,~l ~,Ih.~ ~,v:lt: .~'N~A P~~('.i',~'~ ~ F . ,
~ Iwo. ~ ~I~IfI#Yr'RI't*Y'f*fr~7rYt*tttt*tf~~~#lciM~x~rir'~Y~~~rHfir*~k~r~r~h~F'M'4'R1~*'~ik*AFirir~,a7t*'**trir*w
~A~ ~ , k;t F4UNDRLR , 'i`~-ENT1C' QNE,` ANLY d0 / ~ dQ~ C~OIVL.LII~~ , , i v. r` ~ ;: ,
~'f ~/Vt~ 1.~ ~t,, : ~ 1. .]~ i, f' t ~ IilfAti.~'.1°9 ~ •~' ~a~r,b,
u
P ~
u ~'~ !~ ~ ~ 1 ~ 11 1 1 1 1 111 ~ i./ ~Y~raP(~ 1~ r dt l `n
~~ ,~, ,,~~, ~ III ! II k- I !1 it 111 l ~ Illllf lII.}I~lf}I,ll~1C,~,~~1~i1 ~ ~~~~ ~~,~~, ~ ~ !
x :;.i fi ~.,r. f ~ iJ ~~ It ~' i 1 r"~ ;U`I I(4~,~,.9'~ P~~~' ~ !t ~ ~~~fFg* der
~I ~I ~ I i~~. l 4 i JI ~ I ~ l i lu; t ~. ~ U 1 ~ 1~
' ' ~'~ 1w L Y N` ~~ S~~l'~l GH'~ R7 - ' , ,r k irt~~~~.,,, Ru'~Op i~' , v, ~,~ i, - ~~t ~ , i( ,
~~ Pay ~~~ ~~ ~.5~4 t~12'EA50~1 FiC~A~U ~ `7fa' 4. ~ ..
T.o The ~ D ~ ~4 .. i~, ,,~~
(~ ~~~P~~ 1'7~1~] 6 Vaud N?acik~~a~f~'~1 ~l~tn 4(~~~e ni
'Yhlt i~ 1vtill F~m1 ~, M1~~w~• btEi~r~PL
~ ~ lr~~tl~cat~lild~~~'t~~~ubtj
~ ,~la
~~~ ~ ,
•t ,
~~ .e~r s ~}
G"yia~ i ~ its. ~ ~ Z ~~lta~i~lf
~ fe,y'g'acti ~ ,
r .,, ~ ... ., ~ ,. ~ .. .. •^h 14.e .. .wf• 1t•. ri~.~.. ~ r ..y.. ~ ~ a. .
--^583B~f345~-' o:C~? ?~ L'9 ~7eb ~ 3-58 26"'
kE1lIN BENTOt~a
PAUL H
~ EVELYN W SNUGHART
584 GREASON RaAil
Q
CARLISLE
PA ]70]5
1f~/25!2~~_~ ~'~: "^ ri%'S°5i.5 KEtJIN BEhlTOt~?
PAGE ~2
r ~~~~
SETTLEMENT
iELLEk NAME __ ~, ~ ~~_.~ ~°_ C~ T ~ LL T~ ~ ( ~~ G( i' } ~(
~ _
_OCA~,TION OF SALE C%t ~1 ~^ _C~ ~ C~ ~ ~ ~ ~ _. _
4UC11ONFER ___ ~, ~ ~ ~~ ~ '-1f~,, ~ - ~ ~"'~ ~ ~Ch
~,SE1LrER'S EXPENSES
pROF~55lONAL FEES. .q ~ ~ L
AU~IIONEEft $ ! _,~ , _.
CLERK ~ ~ ~/~ $ - _- - -
CASHIER $
OTHER EXPEt~#SES
~- .. $ .
_...,._ _ ~._r- ~- - -----
---------- _._~r- -_--_ $ _ ~--
5 __~
_ r~
TOTAL EXPENSES ~ ~ ~ 1~1
i~ATE C?F SALE = ~' ~ I ~~ ~ ~ ~
__~
PHONE _- __.___
Z~~
PHONE
CASH ;s _-- _
CHECKS ~' _--! ~: ~ ~ ~ ~
C~TF-iER RECEIPTS
-- .
_ _.. $ ~ ,Gt ~ ~
- $.r--
$.~ ._ _----_ v ..
~ ----
~ _
TOTAL fZECEIF'~5 $_t_~~ I
r
LESS TC7TAL EXPEN5E5 $ .~~ ~ ~f
I`!ET PROCEEDS PAYAPLE TO SELLER $ ~ I r~ / l ~ ''}1
(~ i
I (or we}, the serer, accept this sett{Qrn~nt and aclcnowlc~clge receipt Qf tf,~ a6ave specified net proud{
from r4,e auction of my y s a~~d property sold on tf,e above date. f accept crll respransibili~y for pr~ovidina
m~rrhantc'able title to c~ (goads, ar,d pro;~erty sold, c~nd for delivery of title to the }~urc as~r.
i
Auctian~er or Cashier's Si~natur~ (S~~ler's Signature)
-__ ~ _~- 2 t' I U Dole _ _. .. _ Date ---- -------
~~ ~~ ~j I ~ ,~~~. ~~; ~,,~ f Seder's Signature 1
w
- ~~'~~ , ,- i ~: HOLD DOCUMENT~TO LIGHT TO'VERiFY~WATERMARKS
01 a 5 7 2 ~7 15136536
00000 002 018 051510 02040006 435702 62-22
8i1
CDC FUND pEPT PREP DATE VOUCHER WARRANT ID ~ ~CHECK.tJ~MBER'
WACHOVIA BA(~K p/
PHILADELPHIA, PA na~~nweaCth. o~~e;~,~~~~an'Q -07 1 2 1 O
~S'r~tp .~.~~,~ , .7~ p,~:r,,,~~r / O f ~
VERIFICATIQN AVAfIABLE'- "POSfTIVE'PAY" PROTECTED ~ `~ ~a-rE
PAY (~~ ,
_-.. , . ,
ONL CTS CTS
TO THE ORDER OF 'VOID AFTER 180 DAYS
PAUL SHUGHART `~ *~*~**~_ *~~~~~~r~~
DLN 097000039528 REV REBATE
357 MCALLISTER CHURCH RD # R ti
CARLISLE PA 17015-8963
0
r
...
- I~~~IIL~~III~~~~~JI~I~I~i~~i~i~l~~~II~~~~II~~IJ~I~~~II~~I~1
' ~~ TREASURER OF PENNSYLVANIA'S
11' i 5 i 3 6 5 3 611' ~:0 3 i i00 2 2 5~: 20 ? 9 9 50008 60 211'
r
~e
~lq!H~,r„ l,,;f'",~"1'1~,Iiil,'„l,,r CIE R .1'~11t1'Fd C Aa` E "O F T,;I~T L E~'F O ~ A V,'~,E H~l'C L E , , ~, 1,~ ,
.. I(jl !111111(4-. ~Il r~,7.•„11 :11(11 ill) .l(Imlllll('•rr.,~ ~\: ;..-_-,.._._._ __. _.._.. ~ `'._.._ _.._~ ~ \~_. __. ~.:~ 1`~ ._ ~ .. rr1'a~.-a1,,. i;~vl 11,11 .,,,~k,'~
l l;f 1~1~~r1( ((~llj~(~I l~i;~'1(lll~jill'!r, ~ ~Ijlrp! ,n 1 ~ 11'h !;III(hl 1p1y1 i!1 \ ~ ~ .. ~ 1 , ~},o M,S,1P~;~ ~~11`r,
, I'~~~(11 1111 ~~j,~' II ~ (I 11 ~II ,,,rlll(~~'lll1~, ~! J Illl11~(1 ~ ~~ ,~~,`y1. ~u ,U M4 ~ 111
1 .,
~I1 ~1 ~I ' Jlrfll Ihl I1, ~ ~JI , 11~ I ! ~~ 1,d11y1 `,, '' 1`y1
~ IJJ~Un' „61i~~ 1Qll ",Ilh~lil(I 1~,,!~1,,!~~~~ ,l,.l'I(I;~';I ~~l~jllll~l''IL .I~1111iI~~,~I111~ ~~ ,1````' 1 it~u~l ,111~,1~,~`~
~~`\ ~~~~ - iruw ,... g I~,i1Z, 1 r ' r " ~' ~Fe ipPl1 r f.r .o n o I,rf~a,.. a ~ n ava~,~.~~ ,..oor ~ .. _ ,r. .. ,,... c :_
~ ~\\ a., vFHICLE IDENTIFICATION~NUMBER ,I,~ YEAf~ l~ !,{1,1,1~~11~`j~,l~ ~ 'IMA~E:O1Fl~E' ~,LElll TITLE NUMBER ~~
\c~ ~ _ war:P,~a~ ~llltlllhllh a,llha,9l~~1,;,'III',Ilyl~11i1yII, IB11!411!.111" I;I~~~111~11111~1~11111111111iP~~ul, ~~
~~~~
,.... ,.,., , .: ,. ,...,~,.,..oo,.<.,r..,..,:,.r,.:o,.r.,,,o,., ~a,.,.,:or,r,,,„....,..,.,
,• ,.:,r..«,.r..~o ~ ,,.
~ ~~~ 0QO ~~t1
SDN ~ L ~~:~i~ ~~~~ ~0„~8- D 5
u.a.,n,... ,,yl,., ~>, arny..~,,,fw:o.I ° .nin pris,x.3;:;nnF rJxn acr c. ryaparr. a,., „
~,'~ E!DY•TYPE~~ ~~~pU II ,.,~,~r;~ +i!''1I~,P O ~~TITLEII~"~' T ~07;~;0~:>; ~QI'i'P ~G(yr''4~C1 T 71 ~ODO`M`MILES~~ ~~~~ODOM.~STATUS ;~~°~
,... P s.t. oEA CAP ~~ 4 11~ 41~ ~ . ` (~I ~~, ~J ~ : ~~
,~~ ... :, '`~tiy11111111i~,111dld~li`'` '1111111YlPlilll~l~~ltilliu' ~!gLll~l,lal-; II IP,IIIIIU~'!~9,hU;;r,P:,d:;' , . ~~
~,.,.,,.,.r.,~or,
.: i L 9 r ~ .,., e,, „ ..,..,~,...,~,.,..~ar.,..,a„r..,o,.,..,o,.r..,or,r..o,r..e, .::..r..~or.,...,
9.
...., ..... COQ:: ~~'~+.~8,~:~°4:a,:;..~I„<<~o~,~~~~~,:,.~~~:~..~°; ~.:~°,:,~a;~„ .~ ~•.,;::.:~a•:,.:, ,
... ~~ ~~DATE PA TITLED•~ ~ ,. ~ "•~~ ~~~~~iDATE OF ISSUErO ~~ ",~~ "ha ~",UNLADEN WEIGH7~ ~ ~~ ~~~~~•~~~~ ` ~GVWR~~ ~~~~~~~ ' I ~ ~ ~` ~ • ~~ GCWR~ ~ ~ ~~~~ ~~ ~ I ~ ~ ~ TITLE BRANDS ~~ f f~ ~ ~ f
~~ 4 .~ Ills i ~~n~ Ili I r, r II I i111J(~'NIl'Il 11
q Ir DOIvi6TER STATUS r I ,(1(lUr°
~' '~ I , II i lu rile
1~'lhlllgJ, !,f`~ AC AIl'IM{~EAGE ,I'll(' , Ih ' II I 1
~~ ~1„11(1, N IIII Il,ld,ll~l(llillili~l~~ I~
~ `I il' l ~l Il t MILE~1~~ EXCEEDS THE A~ECH I AL
\\ llli , ur ~ P
~ 661,1 I I r I
. Ild~ 6 1 1 1 1 I I I
~~ ~ .;-. 'I I'111i(Ill ~~ i~( ;~(lll(I'~I U~I'T6',l hI Illy l i111~1 Jll ,h;(I~~~~II;~ I ~,
~~~' ~~ \\ I III 2' NOTJ E /~ TUAL MILE GE 1'
~~ I I,Ijllljil l~rr l~~ II,~ , ~ Il~~l(IIJ(IIIIIIIIIIO ~~
`\~\ ~'` \\~~ _ - 1~l 1111 ~ ~:';'13 NOTjI,TrtEIACITtj,AL MIl!lfAiGE Ogll uM~r~l ' 11
~: ;\ ~ '1' J ~ TAMPE~I~(G . ERIFIEDlllli;n ~% m J ((IV
~~~ _ .. ;~.~~ . _ sb ~ ,.1 ~IIp ., .,fl. ,.iN ~~. (((IlflJlJ~
4 =EXEMPT FROM ODOMETER DISCLOSURE
~ ,pGt~ ~ t~fa~~yt,<- :'~
STERED OWN R~(5`II' +"'! jP' f ' I I r f r Y:~ ` V TITLE BRANDS , i c ~~'
fir ~~I , Il I'i Ilr I(1 I ~< ~~r~ ,1 yy(111(1
r ( ~:., (II,' 1'(iJJI'111~11 I~i ll~~'~Illll !~~ ~~~~~~' f ~ J ~ ~" I A -ANTIQUE WEHICLE ~ 1111`~~,1` 1
~~..lil, .1,111(;;, I.jl,I,l~il l~ 1.1,11. ~ (Ill. ~~fllll ~~ ~~ ~ ~, ~..~ ,1, ~ ~
' J, i1 ~J ILI(jI J /'',jrll~. I t ~ II jl,; J ~ .~\ ''.~ C = CLASSIC VEHICLE ~,,1``1,~`1
~I~~(IIJi H'11,(~f(~11'r~n, 1i'V1 ,'AIt'I I I'A( ~ r t~"~.ul flr(F7Ft ~~` I~n$~iF>`2ut~ z~ D -COLLECTIBLE VEHICLE ~11, ~ 1~,
nllh,~lll! Illl j~lrl rIII'lll~(illll(!j I(1ii10na!'I (It((UIINtlIr! l~~ ~'In ,n r ll,.,,~', ~` _ . _. F -OUT OF000NTRY'y ' ,`,`,1 _1
1, (,~ l,. l J ~ r ~ _ „~\~~__,
M 1 I IIII!. I 1, 16 r /In r I (~ ~~ ~ \ ` ~ ti,RIGINALLI' MFGGy, .`R NO S
.~~~.~ :~(1 ~•' ' I~'I.. r 'll,~~',III~J' J e~rJ~'I4" I III IR C/-7: ~'~ ~ ~>sZ. n~ 1 `'~6~ISTRIBUTION F,. `Ilil~\111'1, 1
Hrull , 1 ~ lllllllll(((~,;~J(Ll'll ~'Ir '.l(J~~ll;':~ l) ~ll~~ll l~~lf ~ , ~' L: X111 11 ~ ~~ ~1~~
~~l,~l ~~ ll ~~IJ'IJJI~~i ~iI11'I ' ~j 1~1 ~'~!~j~ill~jl~l~ll)r) - '~ ~~ ~ H AGRICJLTt1RA Vc ,GLE 11`,1~~1,y111\ri
R ~Ili1,l~ ~ ,11 G1f I r rV1„ I u uJlilr I. n . . .~ , N
L = LOGGIWG VEHICLE ''"`"'
CARLISLE PA 1?D-],-5 I P .IS/WA3APOLICEVENICLE _
\\ ,\, I~~''` Ililyli`` 1, 1 Il II1 ly I!`II I R .RECONSTRUCTED ~ \
~\~~ iIl`~`~~IHh VI`I'I~IIIIII ., `lllly1~~ll~~'11~~I~~~, IIlll~~~~~~ I : jll~ 4 ~~~4'~11 i`i~ S = STREETROD
11,1111 II ,lid ~,IIIII,,yI,II~'1~y~,1' I'1. i111 yi ~I~l ~ 1 l~ ~I~~~ Il! i 11~111~';I
I II I., ,. I ~~ ~ V I l~~ ~ollll~~~~~~ T _REGOVERED TREFi VEHICLE
~1~'I~;lMlil ,,1~~,1,111;1 Illl~l',~II,, ~~IIII,I~IIh', Il I~ti~ , I it 1 „I,
~I~l~,~il 1i11111~I~' I"ill`! 1i ~IIII'1,1 I 'I` I I' ~ Il 1 y~~, V =VEHICLE CONTAINS REISSUED VIII
~!!II`1 ~ `4 ~'`I 'IIl~ I Il yI,I~`1l 1' I `1 ~~~~1}{py~'Itylyl W -FLOOD VEHICLE
\~Q\\.,:. '~I 14~~III III' ~ II~~I! 1~~'. `f1'II hi ~ lltil~l~f~~~ IIII ~~I^. ~~i~~1 ~I.:IIII I~~IIIIIIII~~~ X _~ISIWAS ATAXI .. ,
Ilt~~ll~~i I ~ ~It I', ,, , ~ ~ ~I
FIRST LIEN FAVOR OF. p 1~ 1 l~
! I ~ 11~~1~~U 111 i~~~~~1,~~ ~I~!I~I~~SEC ~ LIE ~ , I ~ OO F'
~~+~1~'i,~~1,~!„~ ~~ ~~,I',YI~~~I~I!ly~"" ~ ~I~~~~~~~~11+` . ~~~Il~~~~!ti11~~~1~~111~!~i11"' ~~'~
i , "IIA I II' , :.. I, ,oil. 1
\ \~~~\ ,',I i j' iii ,III, I) li((I '(op Iilj. i1~111~I~
~v .<. ~wAv~ l'~~I11 II ' JI 'I~~I(I II II iy~ r i II'r,l( ~~II,O
~~~ .. ~\~~~ I~IIII I,'I(I~I: l ~l i'll ! I J I' Il h ~~ol ~'' Illll l'i it ~~l rai IIIIII111 111. ~(II~ I ~ ~~~~'~
~'I Illlp l I II I 1 ( (~~I 11''~II ~I
~~`\ I. s e and Uenholde~ !s listed II on S sfact,o 1 f the ' I st Nen'' the '
\~ti
~~~ ~\ Il)II P , „ ~I a ~~~~ I rl 11'111 (r ~i 11, ~~~` ~, ~~
~" ~ ~iennni7er must forward this Tdlejl ullth I ~U{•ea 1 of~IMot r JUehlclesl~wdh 1
r - appropriate-form ahd fee. ~1~619r(~{ U ~111G ~~~ Ilgl '1"11;, J,( 1(Il~n'I~~I • I
FIRSI LIE-J RF~EAScD _ r~l~~~lr~l)iI :Ill~~ll`l(III"'IIIj~Ill~ll,„ d. ~IIjII~111111J~
DATE .., ii~~~llli.~ril "IJII;(J II'11llllnl~yil.:, '1 ~(~, ~~9~~1~~1~~11
I,~~I:I ', rl~, lln. 1161IIfh
BY SECOND L-tEN RELEASED
AUTHORIZED .REPRESENTATIVE DATE
MAILING ADDRESS
AUTHORIZED REPRESENTATIVE
~t39Ct36 BY _
PAUL H SHUGHART
35? MCALI.ISTER CHURCH
RD
CARLISLE PA L~a15
i •
%` ~ • ~ j ALLEN D BIEHLER
~ I certify as of the date of issue, the official records of the Pennsylvania Department
s ~ of Transportation teflecf that the persdri(s)'or company named herein 7s the fawtul owner
r _. •,.~ • • of the said vehicle. Secretary of Transportation
;a~ sUBSCRIBED AND SWORN if a co-purchaser other than your spouse is fisted and you want the title to
•.:~ T FoR I E: r;''~ r^ , li,, uur be Ilsteti as Joint Tenants With Ri ht of Survv rshi On death.,, f one
~ ,, ,
::..•• , (I 11(j'll (i'' llh„ III II 11 • , _. ~.. ~ 1 d „ ,~1 s,+~~~~,,,
1
( 11 I
l lEE '' I I f r 1 .. „.
;.... -i~~,~(llh Illlrlll:rllf, (ll(l,~~t~l~,lll ~ I, Llrl~~l(Nufl Mo,J11~I1~lICm111au,tido, onv~~ ~ ~~ vEaa ,,a,_ owq~r~tltle, oes t ~survlvln~,owner~1~GHECkIHERE O. t?tharwrse ~~ ~t{ e
.:~~~•~ 'I i I I II IINII,. I., ,,: - rllr I rl d,,; ~~\`;. ~ ~.\~. ~~~~~:: ,:: 11,r,_ 1L\U0.J„yy ,.aa,,N1,. ~,1i\„~1~.111`~1`'yp.
?ifi;;;• IJ IJ ~r IJ~I(III1,1 ,h i,'~jll,~~i' °`' 111J11;i, ylj'd,J'Jr 111 gllrfull l(ilHilr6! IjlJll~l. I~will~~lssued~~s\<renants.,(n Common, (Ori,death of one ovJner, In~~r~ fy
~::' j ~ IIII (~, ~ I Y Ihl~'~(!rl . 111'1 Ilj 11 ~I ~ ~ ~\~ \~ ~ , 1~ „„1,, ;~,1~~~~
~~~'". • 4. l~~ ~ (' ~ )~~ ~( ~ ~) ~~ ~deCe~a~etl :c3vlrner oes to hls/h r heirs or estate . ~ , , 1
"~:~nr~I '~~~~~1~1 I~JI~'1yl~J~l~ qr(1~~ JII''hI'I,,,I h,~~~I!IJY4~~~~ ~I~I~j~I,I~~ ~~Il~'R;'I{11~ vy ~ ~~ ~ 1t
;•q •~ Ilrl1)IILIrIII:Ii,' w 'SII,NAT RE~OF~PEflSON AO IN1 ERI G ATH \~. \\ ` yr ,"~' ~ ~ ~' 1 J,~@
' ;i: t I I "11111 ," ll VIII'.:(t( "111!1 !Inl'!h!I'" 'IIII II fl I I'i'i' ;'tS~~lEri~Dt~TE --~ IF NO LIEN, CHECK ~~ 1~1
~ `Ilj~i~l~ll~~~l I,1' II ill„11 '11iQ' ll!! 1,9,.E 1,!{~;( gJ:,~~lll f(iI1111 ~ilUl iii ~~. ,,~~ „1 ~~
Q . 1 I 1111 l i. ~\: ,1 1,
III I~lllt i i,lihllUlll ,6i1(IGI, li Jl,~n ,I, 111 ~ it ~..;: 11111~~, ~~
- W III~~(1 ' '' rl, Ir r l u, iG IU' \~:~ 1n1~\,,,uA~o,°~
1ST LIENHOLDER
~ ,.111 1~I II~,~
'~_ ' a~ 114~~11~1'111 il,`,,yll;ll,~l 111 ~hii II ~ sT „~ elml,l i },L I II I I `,I
o ; , ~ ,~~i~l~~l`~I~`~I ~~ `' ~lll Ill~l III ' Ii~~~lllhlllllh;~illl'~hl~~~,I
'hI"n I~Illil ~~~~i~l ~~',: a1,I u , p~y1,,,
X114 ~ ~l~ I'~Illlill'~1~1' ~Iy~l'lllli,!, I ~ ,~~~:: I~~ ~~,., ~ ~1~~y,~~ 1i„I 11~~~
`'t~~~j1~~~~1~1j11~~111~1,' ~d~l~lilliP il''1~11i'~ ~I~~~1, ~~~Il~~ll' ~111114~i STP.TE ZIP
W II I I ~ 1~1~II In, ,II I, , ,i~~,ul ,l{ ~ a
Q , ~• y~1~111~~~~1I11~~lllll i1i1~ll~~lly 1111 11 i11111F , ~'IS i~I LT ~fl~ ECK HERE FINANCIAL ~~
~ ~~~~~I~~i~y11111~ ~q~~~~~~ 1~1~~~1 111 NO~,~ II~IN~IRE 111,~~6~„~Ii:• ~ INSTITUTION NO_
fA u,'lll4~rvd1~ ~,I141~~~,1~~1~~~ ~~~ i,~fl~~~
~ 2ND LIEN DATE: • IF NO LIEN CHECK, n
iHlll1i11f11 d111l~I'l~ill .:illlilt {If1' I'N ~.. '!!, ' ''(1(((1(('I)T
e U dersignetl hBre6y makes appliCat on for f ~ a. ^ Trtfe to the veliwle dest~Ibed II rllll,l ll.m)n uurr
~~ve ubJect to Ine e~cumtir, r r~ ~ , , ,. a 3 : a .. .. - 2ND LIENHOLDER '. ~~~'~I1111~ lyi': I JII Il i, f'I li n 1111 ( 11 ` ~' 11 Ill1 l ~l~ll(((Jllf
, I( (JJ I I(b~ 111 I hill i' lull ll 1,
I I , , f,ilii I I ,
~ ~ i111,,1, , llil (,,,~11i:1~ .. y.. 'lrlil~~',iJ lll~~~ ~ Ili
v~ `~ ,,II IIII ,II;I,111Ib1 11,,1„I. u,l Irhl, ,G IN I,J'I~' ~~.~~h.
~~A\.~ q~~ll 1 n, ,11NllJllgi Ilil'(jJlll u I ~(II1j111 r~il!'i'1111j 1111
~ STREET ail(,, 'tl I !1111 :: 111 II 11, j, . u~II ~Il~('' (I'
~~\' SIGNATURE OFAPPLICANT~~. Fi el ~~+ORIZED SIGNER 'I---- ~Il~lll~~"l~~r(111~'~I "'illrl(I~l'IJlrliill~lll +l II~NII(I !~JI II'~~II1jl,~~llllllllflll~~~~l ~l~
"III(,"!d'1!'11'" "nr;ilJ'"'i91~"~~ ~ '=~441d~'~ 'llplll'llfj111111I11'IRtn"'
CITY STATE' ZIP
IF THIS IS AN ELT, CHECK HERE (~ FINANCIAL